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In-Line Lipase Cartridge Associated With Growth Improvements in Young Children Receiving Enteral Nutrition

In-Line Lipase Cartridge Associated With Growth Improvements in Young Children Receiving Enteral Nutrition 1024 683 Lauren Dembeck
Dr. Alvin J. Freeman, MD

Real-world data suggest that an in-line lipase cartridge may help improve weight and nutritional status in young children with fat malabsorption who require enteral feeding.

Young children with fat malabsorption who received enteral formula through an in-line lipase cartridge showed significant improvements in weight and body mass index over 12 months, according to a multicenter real-world study published in Nutrients.

Fat malabsorption can occur as a result of exocrine pancreatic insufficiency, including in children with cystic fibrosis, as well as from conditions such as short bowel syndrome. When children require continuous or overnight tube feeding, providing pancreatic enzyme replacement therapy can be challenging.

“For tube-fed patients with pancreatic insufficiency, delivering pancreatic enzymes can be very difficult,” says A. Jay Freeman, MD, MS, medical director of Pancreatic Care for the Pancreas and Liver Care Center at Nationwide Children’s Hospital and professor of Pediatrics at The Ohio State University College of Medicine. “With conventional enzymes, families may need to administer them every few hours, sometimes throughout the night. An in-line lipase cartridge provides another way to support fat digestion during enteral feeds.”

The study evaluated RELiZORB, a single-use cartridge containing immobilized lipase that connects directly to the enteral feeding circuit and hydrolyzes triglycerides in formula. The device is currently cleared by the U.S. Food and Drug Administration for pediatric and adult use, although evidence on the impact of immobilized lipase cartridge use on growth in children younger than 5 years remains limited.

Dr. Freeman and collaborators retrospectively evaluated data from 186 children who began using the cartridge between ages 1 and 4 years at 90 clinics in the United States. Among 143 children with baseline and follow-up growth measurements, 76% had cystic fibrosis.

After 12 months, mean weight and body mass index z-scores increased by 0.63 and 0.53, respectively, with significant improvement in weight apparent by 3 months. Among children with cystic fibrosis who began using the cartridge at ages 2 to 4 years, the proportion with body mass index at or above the 50th percentile increased from 22% at baseline to 43% at 12 months. Among 1-year-olds with cystic fibrosis, the proportion at or above the 50th percentile for weight-for-length increased from 33% to 65%. Height z-scores increased modestly but not significantly.

“What was reassuring was that the real-world data supported what many of us had been seeing in practice,” Dr. Freeman says. “No individual center had enough patients to draw strong conclusions, but combining data across many centers allowed us to evaluate outcomes in a much larger cohort.”

The researchers emphasize that the findings should be interpreted in the context of the study’s retrospective, real-world design. Without a control group, the study could not isolate the contribution of the cartridge to the observed growth improvements, and information on changes in enteral nutrition, medications, hospitalizations, and cystic fibrosis transmembrane conductance regulator modulator use was not consistently available. The authors also note that the smaller subgroup of children without cystic fibrosis warrants further study.

“For families of children who are tube fed and need pancreatic enzymes, this should at least be part of the conversation,” Dr. Freeman says. “It may not be the right option for every child, but these data provide additional evidence that there is another approach worth considering.”

 

Disclosure: The study was funded by Alcresta. Dr. Freeman declared no conflicts of interest. Additional details can be found in the paper.

 

Reference:

Freeman AJ, Reid E, Schindler T, Sferra TJ, Bice B, Deschamp A, Thomas H, Recker DP, Remmers AE. Real-world evidence of growth improvement in children 1 to 5 years of age receiving enteral formula administered through an immobilized lipase cartridge. Nutrients. 2026;18(2):287. doi:10.3390/nu18020287

Image Credit: Adobe Stock

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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